Provider Demographics
NPI:1528033875
Name:NEISHI, JOHN M (OD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:M
Last Name:NEISHI
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:15070 HESPERIAN BLVD
Mailing Address - Street 2:SUITE G
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94578-3546
Mailing Address - Country:US
Mailing Address - Phone:510-276-8420
Mailing Address - Fax:510-276-6669
Practice Address - Street 1:15070 HESPERIAN BLVD
Practice Address - Street 2:SUITE G
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94578-3546
Practice Address - Country:US
Practice Address - Phone:510-276-8420
Practice Address - Fax:510-276-6669
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-21
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8819T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0269570001OtherNSC
CASD0088190Medicaid
CASD0088190Medicaid
SD0088190Medicare ID - Type Unspecified